NP General Practice: funding

Funding Streams:  We access what funding streams are available for the patients. These include: Under 25 Sexual health, Care Plus (multiple conditions requiring intensive input), Brief Intervention Services (mental health), Diabetes Foot Assessments and Diabetes encounter program (newly diagnosed, re-engagement, initiation of insulin), Palliative care and Free Cervical Smears (>5 yrs since prev smear). These programs allow us to offer a subsidised service for patients with the greatest need.  The benefits of these for the patients cannot be over estimated as often  these people can’t afford to pay and often don’t. There is some benefit to the practice, despite the paperwork involved in order to claim back some money for the service provided.

Maternity: Unfortunately we are unable to claim for any maternity services (under Section 88) as this subsidy can not be paid to a Nurse Practitioner.       Currently we don’t have a GP working in the practice so we continue to provide the services to our maternity, post natal women but unlike my GP colleagues I am not reimbursed by the MOH for this important work.  “Authorised doctors, midwives and specialists can claim maternity services payments to reimburse them for all maternity-related services. New Zealand women are not charged for their maternity care.”  (https://www.health.govt.nz/new-zealand-health-system/)

There have been added benefits to the practice and the population we serve as the cogs of parliament slowly turn and make changes to legislation allowing for NPs to sign off ACC, WINZ forms, Death certs etc. 

There are still barriers that mean the patient pays twice or we subsidise services so as not to disadvantage the patient. For example  a new patient presents to the clinic for  a prescription for natural thyroid hormone which she has been on for some years with good results both physically and showing stable blood tests. I am unable to write this prescription as it is under section 29. So we send a script and a copy of her recent blood tests and consult notes through to a GP colleague who will sign the prescription. This is then sent to the appropriate pharmacy to be dispensed. The GP rightly charges ten dollars for his time and the patient picks up this fee also. This is a barrier to the patient and a significant time and paperwork drain on staff.